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A lot of people want to write to Marius Mason. Since the environmental activist and anarchist was sentenced to 22 years in prison in 2009 for arson and property damage, his case has been a cause celebre in the fight against politically motivated, excessive carceral punishment. Support networks and prisoner letter writing groups are dedicated to getting letters to activist inmates like Mason.

But if you write to "Marius Mason" at the federal prison in which he is held in Fort Worth, Texas, it's likely that the letter won't reach him. You'll have to address the mail to "Marie Mason" instead. This is the name Mason went by before coming out as a trans man to friends and family two years ago. “Marie” is his birth name, his dead name, the name he is fighting to have officially changed while incarcerated in a federal women's prison.


There's reason for hope. In the coming week, Mason will become the first trans man to begin transitioning while in federal custody (as far as his prison warden knows). He was approved to begin hormone treatment last week and expects to receive his first testosterone injection next week. It's a major step in a long journey to have his gender fully affirmed even as his freedom will be denied for years to come.

The prison's approval of Mason's hormone therapy reflects a growing recognition for trans lives that has even permeated prison’s walls. "We should remember that he is in the most restrictive part of a federal prison on a military base in Texas," said Moira Meltzer-Cohen, a New-York based attorney representing Mason for his transition process. "So it feels like a win." Mason has described to contacts the two-year effort for approval of gender-affirming health care as a series of procedures he has "slowly and painfully wended [his] way through."

Mason is not the first person to transition in a U.S. prison, nor the first prisoner to be approved for medical treatment with a gender dysphoria diagnosis. But he is believed to be the first trans man to transition with medical care in federal custody. Thanks to LBGTQ activism and organizing, and in small part to "Orange is The New Black," the struggle of trans prisoners has garnered visibility. The brutality meted out to trans women held in men's facilities has received some much-needed attention. A study by California-based human rights organization, Just Detention, found that 60% of transgender women inmates housed in men's prisons reported being sexually assaulted.


Mason, who hopes to complete gender re-assignment surgeries while in a women's prison and then transfer to a men's facility, will face different hurdles and discriminations than trans women. He treads a little-walked path, hoping to carve it out for other trans prisoners who are punished by a system that still organizes housing according to anatomy. There has even been a delay in getting the "T" to Mason, because the Bureau of Prisons didn't have access to the hormone in its formulary—this is how unchartered Mason's journey is within the prison system.

For LBGTQ communities, the question of treatment in prison is not a fringe issue; 16% of transgender adults have been in a prison or jail, compared to 2.7% of all adults. These figures aren't borne of accident any more than is the justice system's discrimination against black lives. Trans individuals are stigmatized, marginalized, and profiled by law enforcement, only to be imprisoned in institutions historically cleaved into a gender binary.


The right to transition-related health care in prison has been established (and only recognized in recent years) through arguments based on medical need and constitutional protections against cruel and unusual punishment. Last year the U.S. army approved hormone treatment for imprisoned private Chelsea Manning, deeming it "medically appropriate and necessary." The Department of Justice weighed in for the first time in 2015 to affirm that it was constitutionally required that all state and federal prisons treatments meet the medical needs of every trans prisoner individually.

The DoJ’s guidelines aligned with a lawsuit brought by Georgia prisoner Ashley Diamond against the state after the prison officials at the men's facility in which she was held cut off the hormone treatment she had been taking for 17 years. The guidelines asserted that Diamond's Eighth Amendment rights (against cruel and unusual punishment) had been violated in the termination of care, which had been deemed medically necessary before incarceration. But the DoJ went further, stating that the Constitution mandates "individualized assessment and care for gender dysphoria" in all trans prisoners—not just those who had received treatments prior to incarceration.

These federal guidelines consolidated policies established by the Bureau of Prisons since 2011, which demand "individualized assessment and care." But on both state and federal levels, these policies have often been ignored or applied at a snail's pace with resistance or confusion. Meltzer-Cohen told me her and her client’s sense is that “the facility had a directive…but no accompanying protocol." The painstaking delay in Mason’s case, she said, is “part bureaucratic inertia” and “part anxiety” about the fact that Mason is likely the first trans man to transition in federal custody.

Still, even if they’ve dragged their feet, Mason's path to getting "T" shows that prison administrations are willing to honor the rights of trans prisoners. His lawyer did not have to litigate—only, as she put it, "shepherd them to right conclusion." She had the prison send her all of Mason's medical records, which she passed on to an outside medical expert, who wrote a report affirming the medical necessity for gender-affirming treatment—including hormones—and that there were no impeding health risks.


Though the majority didn’t have much experience with trans patients, "the providers caring for Marius believed what he had to say,” explained the author of Mason's external report, Ronica Mukerjee, a family nurse practitioner working on a doctorate at Yale on ethical care of trans patients. But at one point, she said, the providers put an incorrect mental health diagnosis on his chart—a common occurrence for trans people seeking clinical care. Mason's attorney said her client had found the misdiagnosis "hurtful."

But even the correct diagnosis raises some uncomfortable issues. In order to get the right treatment, trans people need to be deemed sufferers of an official condition—gender dysphoria—as defined in the Diagnostic and Statistical Manual of Mental Disorders. Treatments are provided on the condition of a medical necessity, which presumes an inherent sickness attending trans identity. As legal theorist Silpa Maruri notes, “while it allows access to hormone therapy, it does so by describing transgender individuals as somehow sick or infirm” without leveraging a challenge to the world of strict gender binaries in which dysphoria is produced. But for prisoners suffering in their assigned gender and held in America’s behemoth prison system, having the material need for gender affirming treatments recognized can be a matter of life and death. Suicides and attempted suicides are especially common within the incarcerated trans population, discriminated and marginalized as it is.


For Mason, his supporters, and his legal advocates, the next challenge is having his new name be officially recognized along his chosen male pronouns. It’s a central aspect of gender affirmation, and a reminder that gender is not just biological and easily changed medically. As Mukerjee, who has worked in trans care for nine years, said, "The logic is the same [as with hormone therapy]. It is unethical for patients' basic human rights to be ignored when they are in carceral custody. This attention to human rights includes respecting the identity of the patient."


Unfortunately, a medically necessary name change will be harder to achieve than hormone treatment. The states of Texas and Michigan, where Mason could be said legally to reside, forbid name changes for incarcerated people, based on laws designed to prevent convict identity fraud. The old law remains on the books even in this age of totalized surveillance, when the risks of slipping under the state’s radar via an official name change are slim to none. Mason, who has chosen to keep his last name and the same initials, and who will be findable by an inmate number for many years to come, is clearly not attempting identity fraud. Quite the opposite: He is seeking to have his identity affirmed, and a time at which he will no longer receive letters addressed to a dead name.